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• � <br /> P��t�IfilY"A6��L.IC,�T60GV <br /> �1�9LD{�9G I iiii�CE 9��II�AL/PLUE��9N� I�l�N/�IPR1�9��.��/ ��'�fiOL1Y'O�i�l <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.govlpermits <br /> (�I�ae or�facic Infe��ly_�lea.se) PE���A��"�'�A�� IR►����1'l,�`PI�I�1 , <br /> PROJECT SITE ADDRESS: ? Z l:�� �� ��'� PROPERTY TAX#: �' �� �� , '�% L�Z� <br /> LEGAL for new consfruction: Short Plaf/subdivision Lof No. (attach copy of long legal description) <br /> ��PI'TE1�'i' Iid��F2Ni�'�'l��i! <br /> OWNER IVAME: �%FZYt%/'(/�`C/ Z��I`� TENANT NAME(If Commercial): ��/if(���'� Gi il <br /> OWNER MAILING ADDRESS: srReer ��f Z /�i� �r� �-t�-'L� <br /> CITY !�V l�-V�� S"fA7E G�.�'} 7_IP �`'?`' <br /> OWNER PHONE: OWNER GMAIL: <br /> . _.. _ ..__.,.:...._ .. .._. ._ . ........ ..... ... . <br /> ..._..:. . .,._._.._ ,....,._. .. ... ...... . ......... .. ..... ... . .. ...._.._..,.._.. ,.. .. ..,._._ ......,....:... <br /> CONTRACTOR NAME: �U�C��4� �TI��E.-� �t'-E���/t�(,��ic1�L <br /> CONTRACTOR ADDRESS: sTREEr °ZI°7iO (,�l F� �cU(� <br /> CITY !✓Uf�iYC��T STATE �j(f,� ZIP ��J'� <br /> CONTRACTOR PHONE: ��`Z�✓�°�rj 2 P�/I CONTRACTOR EMAIL: �M�J'ZC�- ��' �5��?4=',a= C'��ys� <br /> CONTRACTOR LICENSE�(REQUIRED}: �(J�`r(�.�'jS��,�v�` CITY OF EVERETT BUSINESS LICENSE�(REQUIRED): F,�b �" <br /> PRfMARY CONTACT; ❑OWNER I�.CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT IdAME: CONTACT PHOME: !�Z g�"_�s�d�/�C� <br /> �a� ��c i(�i CONTACT EMAIL: ��� �� ;� ��S/✓/4:�� • �`l <br /> BUILDIN(a PERMIT APPLICATION <br /> Existing Use of Building: 1JC C't�"}�"G= � Contract Price of Wor{c� Z�L�f�'`'�� <br /> Proposed Use of Building: N C ��l'�-�'�'�'�'t Heat Source: ❑Gas C�Eleciric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Atfached ❑Duplex ❑Mulfi-Farnily-#of Uniis: C�Commercial ❑Industrial <br /> Type of Project: ❑New �Addiiion �Remodel 1�Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION O WORK: <br /> � ,� �� L � '� �;.�i �l��� i Il.�c�� ,�'p��`c'v� � lC`�/\`i��"V <br /> �i�yt��%i L l �-� � ?�l>i,i�. b f-.Tl� 5 Gl,�i'T�� 4 � `{! � <br /> � _ , � <br /> ASSOCIATE�BUILDING PERMIT�(if applicable): <br /> M��FiANICAL PERM17'E1�PLI�I17'I�h! P��lM61FdG P�RMITi'�PPI�I�A`i"IOI+�! <br /> Tyne of Projecf: _New_, Addn _Alferafion t�ReE�air � 7ype of Projecf: _New _Addn _Alteration _Repair <br /> #of List of Fixtures ��f List of Fixtures �#�f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixfures Fixtures Fixtures <br /> A/C—Air Handling Unifs ,� Heat Pump Toilef Backflow Prevenfer(Inside Bidg) <br /> Forced Air Sysfems Unit Heafer Ba'thtub Urinal <br /> Gas Piping Boiler Lavatory(Nlash Basin) Drinking Fountain <br /> Water Heafer Reirigeration Shower Floor Drain <br /> Gas Firepface Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clofhes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Wafer lieater Other: <br /> Exhaust Fan Sink(ServiceBadMop/etc.) Other. <br /> �fF��.'�R9f�F���/���PCi'�.�r�7��:9 �SF��I�lllq <br /> Number of Heads <br /> ACl<NOWLEDGEMENT.�I have reviewed this application and confirm the information confained herein is frue and correcf. Work done pursuant to this permif must comply wifh <br /> current federal,state,and locallaw.The granting of a permit only authorizes approved worlt and no deviations fherefrom.Deviations musf first 6e aufhorized in writing fiom fhe <br /> Building Official before beinc�aufhonzed under any circumsfance.!am the owner,or l am authorized by the owner'of this property to perform ti7e ivark for v✓hich application is made, <br /> and l comply with the Stafe Contracfors Law 98.27 RCW and 296.200A WAC. <br /> City of Everetf Otficial Use Only <br /> PERMIT# <br /> '���,-���`' .�� �I / �� ����'`'��:� ,< <br /> �Aufhorizdii. enf Signafure Dafe (fZevised 5/20/2096) �/I <br /> IZ- <br />